The MetroPlus timely filing limit is 90 days from the date of service or discharge, according to MetroPlusHealth’s provider Claims page. A separate MetroPlus notice says it applies the filing provision in each participation agreement, with outer limits of 120 days for participating providers and 180 days for non-participating providers. Your contract controls. Unless your agreement clearly gives you longer in writing, treat 90 days as the deadline.
MetroPlus deadlines at a glance
- Initial claim: 90 days from date of service or discharge (Claims page)
- Participating / non-participating (2023 notice): 120 / 180 days, unless your agreement says otherwise
- Requested records: 30 days from the date MetroPlus requests them
- MetroPlus as secondary payer: 60 days from receipt of the primary EOB
- Payment appeals, NY State products: 45 calendar days from the check or denial notice
- Payment reconsiderations, Medicare and MAP (out of network): 65 calendar days from the remittance notification date
- Late claims, NY State products: reconsideration is possible, and payment may be reduced by up to 25%
Billing teams lose money on MetroPlus when they follow the wrong number from the wrong page, not because they are careless. This guide shows which deadline controls which claim, how to count the days, what to do after a denial, and how to build a workflow that keeps claims inside the window.
What Is the MetroPlus Timely Filing Limit in 2026?
A timely filing limit is the maximum time a payer allows between the date of service and the date it receives your claim. If the claim arrives later and no exception applies, the payer can deny it. Denials for missed deadlines usually carry the CO-29 code, and they are among the hardest denials to reverse.
MetroPlusHealth is the health plan of NYC Health + Hospitals. It runs Medicaid managed care, HARP, Essential Plan, Child Health Plus, Marketplace, NYC employee plans (Gold and GoldCare), managed long-term care, and Medicare HMO and D-SNP plans. Its provider Claims page says claims must be submitted within 90 days of the date of service or discharge, and that page was last updated September 10, 2026.
The complication is that MetroPlus also published a timely filing notice (last updated July 2023) that sets different numbers. If you search the MetroPlus Health Plan timely filing limit, you will find all of them, and each one appears on an official MetroPlus page.
Why MetroPlus Publishes 90, 120 and 180 Days
Here is what MetroPlus’s own pages say:
| Source | What it says | Last updated |
|---|---|---|
| Provider Claims page | Claims must be submitted within 90 days of date of service or discharge | September 10, 2026 |
| Timely claim filing notice | Applies the filing provision in each participation agreement; claims received after 120 days (participating) or 180 days (non-participating) may be denied | July 14, 2023 |
The notice also says the provision applies “unless the participation agreement states an alternative time frame.” MetroPlus doesn’t explain how the 90-day figure and the 120/180-day figures fit together, so what follows is our reading, not an official statement.
How the numbers can coexist: New York’s prompt-pay law, Insurance Law §3224-a, generally gives providers 120 days to submit claims to insurers and HMOs, and it allows plans and providers to agree to different terms in their contracts. For government-program contracts such as Medicaid managed care, the parties can agree to other periods, with a floor of 90 days. Read that way, the 90 days on the Claims page matches the shortest period a Medicaid managed care contract can set. The 120-day number matches the state default. The 180-day number for non-participating providers is MetroPlus’s own policy.
The practical takeaway: Don’t pick whichever number is most convenient. Pick the number your contract supports, and when you can’t confirm it, use the shortest one.
Which MetroPlus Deadline Applies to Your Claim?
Work through these four questions in order.
Step 1: Read your participation agreement
The MetroPlus notice says plainly that your agreement can set a different timeframe. Pull the contract, find the claims submission clause, and record the number of days and the starting event (date of service, discharge, or something else). If the agreement is silent, move to Step 2.
Step 2: Identify the line of business
The Claims page does not split the 90-day rule by plan, and the appeal windows do split by plan. Confirm whether the patient is on Medicaid managed care, HARP, Essential Plan, Child Health Plus, a Marketplace plan, a Gold/GoldCare plan, a managed long-term care plan, or a Medicare plan (Platinum HMO, Advantage D-SNP, UltraCare D-SNP).
Step 3: Confirm your network status on the date of service
A claim for a non-participating provider can fall under the 180-day figure in MetroPlus’s notice, but you shouldn’t count on that if your credentialing was still pending. If your MetroPlus effective date is later than the date of service, claims before that date may be handled differently. Confirm the effective date before billing.
Step 4: Apply the receipt-date rule
MetroPlus’s notice talks about claims received after the deadline. A claim isn’t “filed” when you click submit. It’s filed when MetroPlus receives it, and a claim rejected at the clearinghouse was never received.
Our working rule: use 90 days as the operating deadline for every MetroPlus claim. It’s the shortest published number, it’s on MetroPlus’s current Claims page, and it keeps you safe on every line of business. Treat any longer contractual window as a safety margin for corrections, not as a billing target.
If the contract language is unclear, call MetroPlus Provider Services at 1-800-303-9626 and ask which filing period applies to your agreement. Record the representative’s name, the date and the call reference number.
MetroPlus Timely Filing Limit by Line of Business
| Plan | Initial filing guidance | Payment appeal window | Notes |
|---|---|---|---|
| Medicaid Managed Care | 90 days (Claims page); contract controls | 45 calendar days | NY State product |
| Enhanced (HARP) | Same as above | 45 calendar days | NY State product |
| Essential Plan | Same as above | 45 calendar days | NY State product |
| Child Health Plus | Same as above | 45 calendar days | NY State product |
| Managed Long-Term Care, Partnership in Care (HIV SNP) | Contract controls; 90 days as working rule | 45 calendar days | Confirm with your agreement |
| Marketplace (QHP), Gold, GoldCare | 90 days as working rule | 45 calendar days | Confirm with your agreement |
| Medicare plans (Platinum HMO, Advantage D-SNP, UltraCare D-SNP) and MAP | 90 days as working rule; contract controls | 65 calendar days (out-of-network providers, members, representatives) | Federal Medicare Advantage rules apply to appeals |
A few points need extra attention.
Medicaid managed care claims follow your MetroPlus contract, not fee-for-service rules. Don’t apply eMedNY’s fee-for-service deadlines to a MetroPlus Medicaid claim. Also, you can’t be credentialed by a Medicaid managed care plan without an active New York Medicaid enrollment, so confirm that first.
MetroPlus Medicare plans are not Original Medicare. Billers who apply Medicare’s 12-month rule to a MetroPlus Medicare Advantage claim can miss MetroPlus’s window by nine months. If you need the Original Medicare rule for comparison, see Medicare’s timely filing guidance on CMS.gov.
Behavioral health follows the same discipline. MetroPlus’s behavioral health claims guidance applies whether a provider is paid on a capitated or fee-for-service basis, which means capitated groups still need to submit encounter detail on time.
The Other Deadlines Running Alongside the Filing Limit
Three more clocks run beside the initial deadline, and each starts on a different date. A practice that only tracks the date of service will eventually miss one of them.
MetroPlus as secondary payer: 60 days from the primary EOB
MetroPlus’s notice says the primary payer’s explanation of benefits should be submitted within 60 days of receipt when MetroPlus pays second. Your clock starts when the primary EOB reaches you.
Example: The primary EOB arrives September 8. Sixty days later is November 7, so the secondary claim, with the EOB attached, needs to reach MetroPlus by then.
The delays that cause late secondary claims usually begin at check-in, when nobody asked about other coverage. Run eligibility and coordination-of-benefits checks before the visit so the secondary claim is ready the day the primary payment posts.
Records requests: 30 days
When MetroPlus asks for more information to adjudicate a claim, you have 30 days from the requested date. The clock runs from the date on the request, not the day someone opens it. Assign one person to check MetroPlus correspondence and portal messages every day, and log each request next to the claim with its due date.
Corrected claims: no separate published deadline
As of this writing, we did not find a separate corrected-claim deadline on the MetroPlus Claims page. The safest approach is to treat the original filing window as the limit for corrected claims too, and to confirm any longer window in your contract or with Provider Services.
When you submit a correction, use the correct frequency code: 7 to replace or 8 to void, with the original claim number. On a CMS-1500, that goes in box 22. On a UB-04, it’s the last digit of the type of bill, with the original claim number in field 64.
One rule to remember: a rejection is not a filing. If your clearinghouse rejected the claim, MetroPlus never received it, and the clock kept running.
How to Calculate Your MetroPlus Filing Deadline
Count calendar days forward from the date of service. For inpatient stays, count from the discharge date. Since MetroPlus measures receipt, build your internal deadline well ahead of the final day.
Example: date of service March 3, 2026
| Window | Last day for MetroPlus to receive the claim | Weekday |
|---|---|---|
| 90 days | June 1, 2026 | Monday |
| 120 days | July 1, 2026 | Wednesday |
| 180 days | August 30, 2026 | Sunday |
The 180-day date lands on a Sunday. We didn’t find a MetroPlus rule that moves a weekend or holiday deadline to the next business day, so assume you don’t get that extra day.
Internal targets that protect you:
- Submit every MetroPlus claim within 7 days of the visit.
- Confirm the clearinghouse and payer acknowledgments within 48 hours.
- Flag any unpaid claim at day 45 for follow-up.
- Treat day 60 as the last safe day to fix and resend a rejected claim.
- Treat day 75 as the point where leadership sees any claim still unresolved.
MetroPlus Appeal Timely Filing Limits
MetroPlus’s payment appeal windows depend on the product, according to its Medicare and payment appeals page (last updated September 30, 2026).
| Product | Who files | Deadline | Extra requirement |
|---|---|---|---|
| NY State products (Medicaid, HARP, Essential Plan, CHP and similar) | Provider | 45 calendar days from the initial check or denial notice | Written statement, original claim, EOP, supporting documents |
| Medicare and MAP, out of network | Provider, member or representative | 65 calendar days from the remittance notification date | Waiver of Liability (WOL) statement |
| Medicare and MAP, in network | Provider on the member’s behalf | Use the earliest published date as your target | Appointment of Representative (AOR) form, CMS-1696 |
Example (NY State product): The denial notice is dated October 1. Forty-five calendar days later is November 15, which falls on a Sunday, so aim to have the appeal received by the Friday before.
Example (Medicare, out of network): The remittance notification is October 1. Sixty-five days later is December 5.
What every payment reconsideration needs
MetroPlus lists the required documentation as:
- A written statement explaining why you disagree with the determination or payment amount
- A copy of the original claim
- A copy of the Explanation of Payment (EOP)
- Supporting documentation
- For Medicare and MAP only: an AOR for participating providers, or a WOL statement for non-participating providers
Where to send it, and a discrepancy to check
MetroPlus’s payment appeals page lists MPH Customer Service Appeals, 50 Water Street, 7th Floor, New York, NY 10004, with fax 1-212-908-3011. The provider Claims page lists a different appeals fax (1-212-908-8789) and a Birmingham, AL PO Box for mailed appeals. Because the pages differ, call Provider Services at 1-800-303-9626 to confirm the right destination before you send anything that is close to a deadline, and keep proof of delivery.
After you file
MetroPlus says it will process payment reconsiderations and issue a written explanation within 60 calendar days of receipt. For Medicare and MAP, if the denial is upheld, MetroPlus forwards the case to the Independent Review Entity automatically. Corrections may come as adjustments added to or subtracted from future payments, so match every adjustment back to the original claim.
Missed the Deadline? Late-Claim Reconsideration for NY State Products
Missing the deadline doesn’t always end the claim. MetroPlus’s appeals page says that for NY State products only, providers may request reconsideration of rejected claims submitted after the filing deadline, and payment may be reduced by up to 25%. It also says MetroPlus may pay a claim previously denied for untimely filing if the provider shows the delay was due to unusual circumstances and that the provider typically submits claims on time.
That two-part test tells you how to build the request:
- Document the unusual circumstance. Examples include a clearinghouse outage notice, a documented system conversion, a payer-side processing problem, or a retroactive eligibility change. “We were behind” is not an unusual circumstance.
- Document your pattern of timely filing. Attach a report showing your on-time submission rate for MetroPlus claims over a recent period.
- Show the claim was otherwise clean. A claim with other errors weakens the request.
- Submit inside the appeal window. The 45-day appeal clock still applies to the denial notice.
The page lists this relief under NY State products, so don’t assume Medicare plan claims get the same second chance.
How to Fix a CO-29 Denial: Proving Timely Filing
CO-29 means the time limit for filing has expired (see the X12 claim adjustment reason codes). To overturn it, you need proof that MetroPlus received the claim inside the window, and proof you sent it carries less weight.
Gather evidence in this order, strongest first:
- 277CA claim acknowledgment showing the payer accepted the claim, with the date
- 999 acknowledgment showing your clearinghouse accepted the file
- A MetroPlus claim number or dated claim status screen from the provider portal
- Certified mail receipt with delivery date plus a copy of the paper claim
- The MetroPlus request letter and proof of your response date, for records requests
A 999 proves only that your clearinghouse took the file, so always keep the matching 277CA. Electronic claims go to payer ID 13265; confirm the current clearinghouse route with MetroPlus or your clearinghouse, because MetroPlus’s page still labels the ID with the older Emdeon name.
A simple CO-29 appeal outline
- Header: Provider name, NPI, tax ID, member name and ID, claim number, date of service, billed amount
- Statement: The claim was submitted and received on [date], within [number] days of the date of service
- Evidence list: Each attachment named and dated (277CA, 999, portal screenshot, certified mail receipt)
- Request: Reprocess the claim for payment; if the claim is NY State product business and was late, request reconsideration under the unusual-circumstances provision
- Contact: One named person and a direct phone number
Keep acknowledgment reports for at least as long as your longest appeal window. If CO-29 denials are piling up, a documented denial management process helps you sort which denials are worth appealing, which were your error, and which point to a fixable root cause.
Can You Bill the Patient After a Timely Filing Denial?
No. MetroPlus’s Claims page states that balance billing above allowed co-pays, deductibles or co-insurance for covered services is strictly prohibited, and that a provider who seeks payment from a member for a covered service may be subject to termination. Treat an untimely filing denial as a write-off unless your contract says something different, and have your billing team confirm that with Provider Services before sending any patient statement.
MetroPlus Claims Submission Reference
| Item | Detail |
|---|---|
| Electronic payer ID | 13265 |
| Paper claim forms | CMS-1500 (HCFA) or UB-04 |
| Paper claims, all plans including Medicare | MetroPlus Health Plan, PO Box 830480, Birmingham, AL 35283-0480 |
| Provider Services (claim status) | 1-800-303-9626 |
| Payment appeals (NY State products and Medicare payment reconsiderations) | MPH Customer Service Appeals, 50 Water Street, 7th Floor, New York, NY 10004; fax 1-212-908-3011 |
| Provider portal | providers.metroplus.org |
The MetroPlus provider phone number for claims status and timely filing questions is 1-800-303-9626, and it is staffed Monday to Friday, 8 a.m. to 6 p.m. Eastern. Send anything near a deadline by certified mail or another trackable method, and keep the delivery record.
How MetroPlus Compares With Other New York Payers
If your practice bills several New York plans, one rule across all of them is a trap. Compare the guides before you build payer rules into your billing system:
- Fidelis Care: Read our Fidelis timely filing limit guide for deadlines by plan and state. It’s the closest peer for New York Medicaid managed care work.
- Healthfirst: Healthfirst’s 180-day window is far more generous than MetroPlus’s 90-day working rule, so a practice that bills both can’t share one deadline across them.
- NY Medicaid fee-for-service: The eMedNY Guide to Timely Billing sets its own rules. They are a useful benchmark but they don’t govern MetroPlus managed care claims.
The lesson is to store the deadline per payer and per line of business in your practice management system, and review it every quarter.
8 Common MetroPlus Timely Filing Mistakes
- Using 180 days because you saw it on one page. That figure is for non-participating providers and doesn’t override your contract.
- Counting from the submission date instead of the receipt date. A claim sent on day 89 can land late.
- Treating a clearinghouse rejection as a filing. A rejected claim was never received.
- Waiting for the secondary clock to start at the date of service. It starts when the primary EOB arrives.
- Missing the 30-day records window. Unread portal messages and mailroom delays are the usual cause.
- Applying Original Medicare’s 12-month rule to MetroPlus Medicare plans.
- Filing an appeal on the wrong clock. NY State products use 45 days, and Medicare and MAP use 65.
- Not saving acknowledgments. Without a 277CA, a CO-29 appeal becomes your word against the payer’s record.
A Day-by-Day Workflow That Keeps Claims Inside the Window
| Day | Action | Owner |
|---|---|---|
| Before the visit | Verify eligibility, plan type and other coverage; confirm network status and prior authorization | Front desk |
| Day 0 | Complete documentation and charge capture | Provider / coder |
| Day 1–3 | Code review and scrub the claim for errors | Coder / biller |
| Day 7 | Claim submitted; internal deadline met | Biller |
| Day 9 | Confirm 999 and 277CA acknowledgments | Biller |
| Day 14 | Rejections fixed and resubmitted | Biller |
| Day 30 | Check claim status in the portal | AR team |
| Day 45 | Flag unpaid claims for follow-up | AR team |
| Day 60 | Last safe day to fix and resend | Billing lead |
| Day 75 | Escalate anything unresolved | Practice manager |
| Day 90 | Hard stop for the working deadline | Everyone |
Role-based checklists
Front desk: Collect insurance and other coverage at scheduling and check-in. Confirm the plan name, not just the carrier name. Scan both sides of every card.
Coders and billers: Scrub every claim before submission. Save every acknowledgment. Log every records request with its due date.
Practice managers: Review a weekly aging report by payer. Audit one sample of MetroPlus claims each month against the day-7 submission target.
KPIs to Track for MetroPlus Claims
| Metric | Why it matters | Target to aim for |
|---|---|---|
| Days from service to submission | Shows how much of the window you use | Under 7 days |
| First-pass acceptance rate | Rejected claims eat the window | Above 95% |
| CO-29 denials per month | Direct measure of timely filing leakage | As close to zero as possible |
| Claims over 60 days unresolved | Early warning for deadline risk | Trending down |
| Secondary claims submitted within 60 days of the primary EOB | Protects COB revenue | 100% |
| Appeals filed inside the window | Shows whether you protect appeal rights | 100% |
These targets are our recommended operating goals, not MetroPlus requirements.
How Credexa Solutions Helps You Stay Ahead of MetroPlus Deadlines
Tracking 90-day, 60-day, 45-day, 30-day and 65-day clocks across several payers is where most practices slip. Credexa Solutions helps healthcare practices manage the revenue cycle, from claim submission and denial management to AR follow-up, so claims go out clean and on time.
Here is how that works in practice for MetroPlus work:
- Accurate coding before submission. Many timely filing problems start as coding or data errors that trigger rejections and resubmissions. Our team reviews claims for accuracy first, so the first submission is the one that sticks.
- Deadline-based claim prioritization. Claims are worked by how close they are to the filing window, not just by age or dollar amount.
- Denial management. When a CO-29 or other denial arrives, we identify the root cause, gather the right proof and file the appeal on time. See our medical billing services for more.
- AR follow-up. Our AR follow-up work catches stalled claims before they cross the deadline.
- Credentialing support. If you’re joining a payer’s network, our provider credentialing and contracting team helps you confirm effective dates before you bill, so claims don’t go out ahead of your enrollment.
If MetroPlus claims keep aging past day 60 in your AR, book a free billing audit with Credexa Solutions and we’ll show you where claims are stalling and what it costs you.
MetroPlus Timely Filing Limit FAQs
What is the MetroPlus timely filing limit?
MetroPlus’s provider Claims page says claims must be submitted within 90 days of the date of service or discharge. A separate notice applies the timely filing provision in each participation agreement, with 120 days for participating and 180 days for non-participating providers. Your contract controls, so use 90 days unless you can confirm otherwise in writing.
What is the MetroPlus Health Plan timely filing limit for participating providers?
MetroPlus’s notice lists 120 days from the date of service or discharge for participating providers, unless the participation agreement states another timeframe. Because the Claims page lists 90 days, billing to 90 days is the safest practice.
What is the MetroPlus timely filing limit for non-participating providers?
MetroPlus’s notice lists 180 days from the date of service or discharge for non-participating providers. Out-of-network payment rules may also apply, so check the member’s benefits before relying on that window.
What is the MetroPlus appeal timely filing limit?
For NY State products, payment reconsiderations must be received within 45 calendar days of the initial check or denial notice. For Medicare and MAP, out-of-network providers, members and authorized representatives have 65 calendar days from the remittance notification date.
What is the MetroPlus corrected claims timely filing limit?
We did not find a separate published corrected-claim deadline. Plan around the original filing window, use frequency code 7 or 8 with the original claim number, and confirm any longer window in your contract or with Provider Services.
Is there a MetroPlus secondary claim deadline?
Yes. MetroPlus’s notice says the primary payer’s EOB should be submitted within 60 days of receipt when MetroPlus is the secondary payer.
What is the MetroPlus claims mailing address?
The Claims page lists MetroPlus Health Plan, PO Box 830480, Birmingham, AL 35283-0480 for paper claims, for both Medicaid-type plans and Medicare plans. Confirm with Provider Services before mailing anything close to a deadline, and send it by certified mail.
What is the MetroPlus provider phone number for claims?
Call Provider Services at 1-800-303-9626 for claim status and timely filing questions.
Can I appeal a MetroPlus timely filing denial?
Yes, inside the appeal window for your product. For NY State products, MetroPlus says late-claim reconsideration may be available with a payment reduction of up to 25%, if you show unusual circumstances and a pattern of timely filing.
Can I bill the patient if MetroPlus denies a claim for late filing?
MetroPlus prohibits balance billing above allowed co-pays, deductibles and co-insurance for covered services. Treat the denial as a provider write-off unless your contract says otherwise.
Sources
- MetroPlusHealth: Claims
- MetroPlusHealth: Important Update, Timely Claim Filing Requirements
- MetroPlusHealth: Medicare Grievance, Coverage Determination and Appeals (payment reconsiderations)
- New York State Senate: Insurance Law §3224-a
- eMedNY: Guide to Timely Billing
- CMS: Form CMS-1696, Appointment of Representative
- X12: Claim Adjustment Reason Codes
Payers update their pages without notice. This guide reflects MetroPlus’s published information as of October 2026. Confirm deadlines against your participation agreement and the current MetroPlus pages before relying on them.
